History of present illness: Mr. F. is a 55-year-old advertising executive who comes to the emergency room complaining of pain in his chest that began 1 hour ago. He describes the pain as pressure under the sternum that radiates into his left arm and up into his jaw. On a scale of 1 to 10, he rates it as a 7 in intensity. He feels short of breath. He has had similar symptoms during the last 2 weeks, but these episodes have lasted for 5 to 10 minutes at the most. He noticed that the symptoms are brought on by climbing stairs and are relieved with rest. Right now, he reports nausea and sweating. He was given sublingual nitroglycerin by the triage nurse in the emergency room, which has helped to ease the pain. Mr. F. denies any palpitations,
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Clinical findings upon initial evaluation strongly indicate that the patient needs oxygen, chewable aspirin, morphine, and nitroglycerin. My other hypothesis is that he is currently experiencing unstable angina. “Unstable angina (a medical emergency) occurs at rest, is a change in your usual pattern of angina, is unexpected, is usually more severe and lasts longer than stable angina, maybe as long as 30 minutes, may not disappear with rest or use of angina medication” and “might signal a heart attack” (“Angina,” n.d.). The differences between a heart attack and unstable angina are that a heart attack refers to blood flow that has become blocks and with unstable angina the blood flow may not be blocked completely, however, there is very limited flow (“Heart Attack,” n.d.). A patient with unstable angina should go to the nearest emergency room if they are having no relief or are experience additional symptoms different than their usual episodes. My third diagnosis is that he may have myocarditis, which often presents like a heart attack. “Myocarditis is an inflammation of the myocardium, the middle layer of the heart wall. Myocarditis can affect both the heart’s muscle cells and the heart’s electrical system, leading to reduction in the heart’s pumping function and to irregular heart rhythms” (“Myocarditis,” n.d.). Many things can cause myocarditis and it is usually the result of some type of infection. This infection can be a virus, …show more content…
For instance, a twenty-five-year-old healthy female is not going to have the same heart when she is seventy. Over time, the body goes through physical changes and as we age our body loses some function. Differentiating what is normal and what is not in an elderly patient is necessary to understand in the health care field. “For example, atherosclerosis is pathological: it is not present in health elderly patients. On the other hand, a reduction in arterial elasticity caused by fibrosis of the media is part of the normal aging process” (“Aging,” n.d.). This reduction in arterial elasticity can increase afterload, cause hypertension and enlarge the heart to a certain degree (“Aging,” n.d.). Baroreceptor function also declines and as a result, the heart cannot detect pressure changes (“Aging,” n.d.). Blood pressure in children is different than those in adults due to their workload. A child that is two years old does not need a blood pressure of 120/80 because their body surface area is smaller and thus the heart does not need to work as hard. As we age our surface area gets larger and the heart must work harder to accommodate this. These are all changes that happen over a
Clinical findings upon initial evaluation strongly indicate that the patient needs oxygen, chewable aspirin, morphine, and nitroglycerin. My other hypothesis is that he is currently experiencing unstable angina. “Unstable angina (a medical emergency) occurs at rest, is a change in your usual pattern of angina, is unexpected, is usually more severe and lasts longer than stable angina, maybe as long as 30 minutes, may not disappear with rest or use of angina medication” and “might signal a heart attack” (“Angina,” n.d.). The differences between a heart attack and unstable angina are that a heart attack refers to blood flow that has become blocks and with unstable angina the blood flow may not be blocked completely, however, there is very limited flow (“Heart Attack,” n.d.). A patient with unstable angina should go to the nearest emergency room if they are having no relief or are experience additional symptoms different than their usual episodes. My third diagnosis is that he may have myocarditis, which often presents like a heart attack. “Myocarditis is an inflammation of the myocardium, the middle layer of the heart wall. Myocarditis can affect both the heart’s muscle cells and the heart’s electrical system, leading to reduction in the heart’s pumping function and to irregular heart rhythms” (“Myocarditis,” n.d.). Many things can cause myocarditis and it is usually the result of some type of infection. This infection can be a virus, …show more content…
For instance, a twenty-five-year-old healthy female is not going to have the same heart when she is seventy. Over time, the body goes through physical changes and as we age our body loses some function. Differentiating what is normal and what is not in an elderly patient is necessary to understand in the health care field. “For example, atherosclerosis is pathological: it is not present in health elderly patients. On the other hand, a reduction in arterial elasticity caused by fibrosis of the media is part of the normal aging process” (“Aging,” n.d.). This reduction in arterial elasticity can increase afterload, cause hypertension and enlarge the heart to a certain degree (“Aging,” n.d.). Baroreceptor function also declines and as a result, the heart cannot detect pressure changes (“Aging,” n.d.). Blood pressure in children is different than those in adults due to their workload. A child that is two years old does not need a blood pressure of 120/80 because their body surface area is smaller and thus the heart does not need to work as hard. As we age our surface area gets larger and the heart must work harder to accommodate this. These are all changes that happen over a